Socioeconomic Status Predicts Mortality in Melanoma

Race and ethnicity is not linked to increased melanoma-specific mortality in insured patients.

Socioeconomic status (SES) is a strong predictor of melanoma-specific mortality among insured patients with melanoma, and minority race/ethnicity is not, according to a study in the Journal of the American Academy of Dermatology.

Investigators aimed to assess the association of race/ethnicity and SES with melanoma-specific mortality within an insured population of patients. Adults aged 20 years and older diagnosed with stages I through IV melanoma were identified from 6 counties in southern California within the California Cancer Registry (CCR) from January 1, 2009, through December 31, 2014.

Person-year (PY) melanoma-specific mortality rates and 95% confidence intervals were calculated according to race/ethnicity and SES for the overall population (n=14,614 melanoma diagnoses) and were then stratified by health care system — Kaiser Permanente Southern California (KPSC; n=4701 melanoma diagnoses) and outside private insurance (OPI; n=9913 melanoma diagnoses). Multivariable-adjusted hazard ratios (HR) were estimated with use of Cox proportional hazards models, adjusted for the covariates.

After the 8-year maximum follow-up, 890 (6.1%) melanoma-specific deaths occurred overall, 231 (4.9%) occurred in the KPSC population, and 659 (6.6%) occurred in the OPI population. A majority of the deaths occurred in patients older than 65 years (58.4%, 61.6%, 60.8%) for the KPSC, OPI, and total population, respectively. Non-Hispanic Whites accounted for the majority of all cases of melanoma (83.0%, 88.0%, 86.4%) and deaths (84.4%, 90.0%, 88.5%) for the KPSC, OPI, and total population, respectively.

…health insurance coverage may have confounded the previously documented racial disparities among melanoma patients.

In multivariate analyses in the KPSC population, minority race was not associated with an increased risk for melanoma death as all confidence intervals crossed the null of the reference population, which was non-Hispanic Whites. Comparable trends were observed in the OPI group and in the total population, except Hispanics had a slightly decreased risk for dying from melanoma in the total population (HR 0.72; 95% CI, 0.56-0.93) and in the OPI population (HR 0.67; 95% CI, 0.49-0.92), compared with non-Hispanic White persons.

Multivariable analyses showed that lower SES was associated with an increased risk for melanoma death for patients in the OPI population, but not for those in the KPSC population. In the OPI group, with the upper quintile as the reference population, patients in the lowest socioeconomic quintile had a 70% increased risk for dying (HR 1.7; 95% CI, 1.22-2.38) from their melanoma compared with the wealthiest patients. In addition, patients in the lower-middle quintile had a 48% increased risk for melanoma death (HR 1.48; 95% CI, 1.15-1.90). The confidence interval for these HRs did not cross the null, which indicates that lower SES is a significant risk factor for melanoma-specific mortality. For the KPSC population, multivariate analysis demonstrated that SES does not affect melanoma-specific mortality, as all confidence intervals crossed the null.

Among several study limitations, data were not available regarding location of care delivery after cancer diagnosis, comorbidities, smoking status, or physical activity. Also, the study relied on the state’s cancer registry categorization of race/ethnicity, and adequate data were unavailable for certain race/ethnic groups, such as Native Americans.

“We demonstrate that race/ethnicity is not associated with increased melanoma-specific mortality among insured individuals, suggesting that health insurance coverage may have confounded the previously documented racial disparities among melanoma patients,” stated the study authors. “Our data also underscore the persistence of socioeconomic disparities within an insured population of melanoma patients cared for in nonintegrated health care systems, but not for those cared for within integrated health care systems.”

References:

Rosenthal A, Reddy S, Cooper R, et al. Disparities in melanoma-specific mortality by race/ethnicity, socioeconomic status, and healthcare systems. J Am Acad Dermatol. Published online October 10, 2022. doi:10.1016/j.jaad.2022.10.004